Satisfaction with male-to-female gender reassignment surgery.

BACKGROUND: The frequency of gender identity disorder is hard to determine; the number of gender reassignment operations and of court proceedings in accordance with the German Law on Transsexuality almost certainly do not fully reflect the underlying reality. There have been only a few studies on patient satisfaction with male-to-female gender reassignment surgery. METHODS: 254 consecutive patients who had undergone male-to-female gender reassignment surgery at Essen University Hospital's Department of Urology retrospectively filled out a questionnaire about their subjective postoperative satisfaction. RESULTS: 119 (46.9% ) of the patients filled out and returned the questionnaires, at a mean of 5.05 years after surgery (standard deviation 1.61 years, range 1-7 years). 90.2% said their expectations for life as a woman were fulfilled postoperatively. 85.4% saw themselves as women. 61.2% were satisfied, and 26.2% very satisfied, with their outward appearance as a woman; 37.6% were satisfied, and 34.4% very satisfied, with the functional outcome. 65.7% said they were satisfied with their life as it is now. CONCLUSION: The very high rates of subjective satisfaction and the surgical outcomes indicate that gender reassignment surgery is beneficial. These findings must be interpreted with caution, however, because fewer than half of the questionnaires were returned.

Eating disorders, trauma, PTSD, and psychosocial resources.

The frequency of traumatic events and comorbid post-traumatic stress disorder (PTSD) in women with eating disorders (ED) was assessed. Also, patients with anorexia nervosa (AN) and bulimia nervosa (BN) were compared; post-traumatic symptomatology and the role of psychosocial resources were analyzed. One hundred three ED patients (29.1±10.5 years) were studied through the use of standardized questionnaires. We found that 23.1% of AN and 25.5% of BN patients fulfilled the study definition for a current diagnosis of PTSD. Cumulative traumatization led to more severe symptomatology. Psychosocial resources were found to have strong associations with symptomatology. These findings provide additional support for the association between traumatization and ED. Clinical interventions for traumatized ED patients may benefit from a focus on post-traumatic stress symptomatology and personal resources.

Anxiety, posttraumatic stress, and fear of cancer progression in patients with melanoma in cancer aftercare.

UNLABELLED: Several studies have described mental distress and anxiety in patients with melanoma. The findings of these studies varied from patients with a quality of life similar to the general population and those with increased mental distress. In the present study, we investigated anxiety, posttraumatic stress, and fear of cancer progression to gain a detailed picture of the burdens of these patients. PATIENTS AND METHODS: 70 patients with malignant melanoma who attended cancer aftercare were surveyed using the psychometric instruments Hospital Anxiety and Depression Scale (HADS), Posttraumatic Symptom Scale (PTSS-10), and Fear of Progression Questionnaire (FoP-Q). The questionnaires were evaluated and an analysis of the single items carried out. RESULTS: The scores for the three anxiety parameters were low, but 7% of the patients presented an increased HADS score, and 17% an increased PTSS-10 value. An analysis of the items showed that patients feared physical disabilities more than mental distress or lack of social support. CONCLUSION: Most of the patients perceived themselves as stable, and relied on the assistance of their families. However, a small group of patients suffered from clinically relevant anxiety; these patients should be given the support indicated for their specific distress.

[Mental health of Polish immigrants compared to that of the Polish and German populations]. / Die Psychische Gesundheit Polnisch-Stämmiger Migranten im Vergleich zur Polnischen und Deutschen Bevölkerung.

OBJECTIVES: This survey examines the mental health of immigrants of Polish origin compared to samples from the Polish and German populations. METHODS: In a sample of 513 subjects (261 persons with Polish migration background and 252 autochthone Poles) depression (BDI), anxiety (BAI), and somatic complaints (GBB-24) were measured. RESULTS: Immigrants of Polish origin showed a significantly higher level of anxiety as well as somatic complaints but only a tendency toward higher depressiveness than the German normvalue, but not than that of the native Poles. Female immigrants showed an overall higher number of symptoms in the three domains in question compared to German women and - except for depressiveness - also compared to male immigrants. CONCLUSIONS: Persons with a Polish migration background present levels of mental distress higher than the general German population, but similar to the population of their country of origin. Further research is needed to clarify the special structure of the mental morbidity in Polish immigrants.

Influence of kinship on donors' mental burden in living donor liver transplantation.

In the context of living donor liver transplantation (LDLT), German transplantation law stipulates that donor candidates should primarily be relatives of the recipients or persons with distinct and close relationships. In this study, we investigated the influence of the relationship between the donor and the recipient on the donor's emotional strain before transplantation. Donors were categorized according to the following subgroups: (1) parents donating for their children, (2) children donating for their parents, (3) siblings, (4) spouses, (5) other relatives, and (6) nonrelatives. The sample consisted of 168 donor candidates. Anxiety (F = 2.8, P = 0.02), depression (F = 2.6, P = 0.03), and emotional quality of life (F = 3.1, P = 0.01) differed significantly according to the relationship between the donor and the recipient. In comparison with healthy controls, parents donating for their children were significantly less stressed before LDLT and demonstrated fewer anxiety (P < 0.01) and depression symptoms (P < 0.05). Adult children donating for their parents demonstrated the highest mental burden and the lowest emotional quality of life. However, this was not due to the responsibility of these children for their own families because differences between donors with children and donors without children could not be ascertained. This group should be given special attention before LDLT and during follow-up visits, and psychological help should be provided when it is necessary.

[Prevalence, comorbidity and severity of psychosomatic disorders in outpatients with Turkish migration background]. / Prävalenz, Komorbidität und Ausprägungsgrad psychosomatischer Erkrankungen bei ambulanten Patienten mit türkischem Migrationshintergrund.

In this study the prevalence and comorbidity of mental disorders were examined for the first time with the Structured Clinical Interview for DSM-IV (SCID-I) in a consecutive sample of Turkish speaking patients (n=51). The symptom severity of the depressiveness was measured with the Beck Depression Inventory (BDI), of the somatoform complaints with the Screening for Somatoform Symptoms (SOMS) and of the posttraumatic stress disorder (PTSD) with the Essen Trauma Inventory (ETI). The most common current diagnoses were the somatization disorder (41.2%; n=21), a single episode of major depression (37.3%; n=19) and the PTSD (31.4%; n=16). In 80.4% (n=41) of the patients at least one comorbid mental disorder was documented. In comparison with German reference values the Turkish patients showed a significant higher severity of the depressive and posttraumatic, however not of the somatoform symptomatology.

[The Essen Trauma-Inventory for children and adolescents (ETI-CA)]. / Das Essener Trauma-Inventar für Kinder und Jugendliche (ETI-KJ).

OBJECTIVE: In light of the clinical and scientific relevance of traumatic events and posttraumatic disorders our study aimed to develop and validate the Essen Trauma-Inventory for Children and Adolescents (ETI-CA). The new instrument should assess various aspects of traumatic events and both posttraumatic disorders, namely Posttraumatic Stress Disorder and Acute Stress Disorder according to the criteria provided in DSM-IV. METHOD: ETI-CA was administered to a sample consisting of 276 children and adolescents aged between 12 and 17 years with regard to psychometric properties on clinical and non-clinical groups. RESULTS: The ETI-CA subscales as well as the total score proved to have high internal consistency. The 4-factorial structure (intrusion, avoidance, hyperarousal, dissociation) was in line with the theoretical assumptions. Associations between ETI-CA and other trauma instruments as well as instruments for psychological distress and protective factors provided empirical evidence for the construct validity of ETI-CA. CONCLUSIONS: In German-speaking regions, the ETI-CA represents the first economic, reliable and valid screening instrument that assesses exposure to a broad range of potential traumatic events as well as posttraumatic disorders. The ETI-CA can be recommended for use in research as well as in clinical settings.

[Effects of inpatient treatment on eating disorder symptoms, health-related quality of life and personal resources in anorexia and bulimia nervosa]. / Effekte stationärer Psychotherapie auf Essstörungssymptomatik, gesundheitsbezogene Lebensqualität und personale Ressourcen bei Anorexia und Bulimia nervosa.

The aim of the present prospective-naturalistic study was the evaluation of psychosomatic inpatient treatment for anorexia nervosa (AN) and bulimia nervosa (BN). 128 patients with eating disorders (n=59 AN and n=69 BN) were investigated on admission and discharge using the following standardized questionnaires: eating disorder symptoms (EDI), general psychopathology (BSI), quality of life (SF-12), and personal resources (SOC-13, SWE). Moderate to large effect sizes were achieved for the eating disorder symptoms; in addition, general psychopathology was substantially reduced at the end of treatment, and quality of life as well as personal resources were enhanced. Personal resources were found to be the strongest predictors for therapy outcome. Based on our data, important insights and recommendations may be gained for the inpatient treatment of eating disorders, especially with regard to the potential influence of personal resources.

Effects of gustatory stimulation on brain activity during hunger and satiety in females with restricting-type anorexia nervosa: an fMRI study.

BACKGROUND: Previous research has demonstrated altered neuronal responses to visual stimulation with food in anorexia nervosa, varying with the motivational state of hunger or satiety. The aim of the present fMRI study was to assess hunger- and satiety-dependent alterations in the gustatory processing of stimulation with food in anorexia nervosa. METHODS: After food abstention (hunger condition) and after eating bread rolls with cheese (satiety condition), 12 females with restricting-type anorexia nervosa and 12 healthy females drank chocolate milk and water via a tube in a blocked design during image acquisition. Additionally, heart rate was registered during the measurements, and subjective ratings of hunger/satiety and of the valence of chocolate milk were assessed using a Likert scale. RESULTS: In participants with anorexia nervosa, drinking chocolate milk in the hunger condition induced significant activations in the right amygdala and in the left medial temporal gyrus relative to healthy controls. When contrasting neuronal responses to drinking chocolate milk during satiety with those evoked during hunger, a significant activation was found in the left insula in healthy controls, whereas in participants with anorexia nervosa, neuronal activity in the inferior temporal gyrus, covering the extrastriate body area, was observed. CONCLUSIONS: Neuronal responses evoked by gustatory stimulation differ depending on hunger and satiety. Activations located in the amygdala and in the extrastriate body area might reflect fear of weight gain, representing one of the core symptoms of anorexia nervosa.

[Validation of the German translation of the Eating Disorders Quality of Life (EDQOL)]. / Validierung der deutschen Übersetzung des Eating Disorders Quality of Life (EDQOL).

The aim of the study was the translation and validation of a disease-specific questionnaire (Eating Disorders Quality of Life, EDQOL) to measure the health-related quality of life of eating-disordered patients. 195 patients with eating disorders and 109 healthy controls were examined by EDQOL and other instruments (SF-12, EDI, FKB-20, SEED, BSI, IIP-D and SOC-13). The EDQOL total score proved to have a high internal consistency. The four factorial structure of the original version was confirmed. There were indications of very good construct validity and a good sensitivity for change. For the first time, in the German-speaking part there is an economic, reliable and valid instrument that assesses the specific health-related quality of life for patients with eating disorders which is recommended for use in research as well as in clinical settings.

Sense of coherence and depression in the framework of immigration: Turkish patients in Germany and in Turkey.

The present study explores sense of coherence (SOC) levels in two clinical samples (outpatients with neurotic disorders) with the same Turkish cultural background in comparison to the German reference values as well as the association between SOC and depression and the protective role of SOC. A total of 96 Turkish patients in Germany (36.67 ± 9.52 years) as well as 60 local Turkish patients (38.57 ± 10.15 years) have been examined for SOC measured with the Sense of Coherence scale (SOC-29) and depression with the Beck Depression Inventory (BDI). Both samples scored significantly lower for SOC compared to the normal Turkish and German population and to German subjects with psychiatric symptoms (p < 0.001) but did not differ significantly from each other. Negative significant correlations were found between SOC and the degree of depressiveness in both groups (immigrants: r = -0.59, p < 0.001; Turks: r = -0.51, p < 0.001). Multiple regression analyses including SOC, age, gender, education, marital and employment status have demonstrated SOC to be the strongest predictor for depressiveness. SOC can be regarded as a protective factor for depression in patients with Turkish migration background in Germany and in local Turkish patients. However, further studies are needed to clarify if the concept SOC can be used adequately in collectivistic cultures as, for example, the Turkish one.

Influence of satiety and subjective valence rating on cerebral activation patterns in response to visual stimulation with high-calorie stimuli among restrictive anorectic and control women.

BACKGROUND: There is evidence that patients with anorexia nervosa (AN) demonstrate specific cerebral activation patterns in response to visual food stimulation. We postulated that cerebral activation patterns could represent different perceptions of high-calorie images during hunger and satiety and could be determined by patients' subjective ratings. METHODS: After 6 h of starvation and also in a state of satiety, 12 female patients with AN and 12 normal-weight women were assessed by use of fMRI with high-calorie food images. All patients suffered from a restrictive type of AN. Heart rates, subjective ratings of satiety and valences of the visual stimuli were assessed. RESULTS: Food stimuli presented during a state of hunger were associated with significant activation of the anterior cingulate cortex and insula in the control group and of the prefrontal and central cortices and insula in the AN group. During the hunger state activation in AN of the dorsal posterior cingulate cortex was revealed compared to the controls. In the state of satiety, activation of the left insula was observed in the AN group. Use of the food valence judgment as a covariate confirmed the insula activation and revealed additional activation of the orbitofrontal, cingulate and medial temporal cortices. CONCLUSION: Our results indicate differences in cerebral activation patterns due to different perceptions of high-calorie food images, modulated by feelings of hunger or satiety, among AN patients with modulation by subjective ratings of food valence.

Traumatic events, posttraumatic stress symptomatology and somatoform symptoms in eating disorder patients.

OBJECTIVE: The central aim of the study was to assess the frequency of traumatic events and comorbid posttraumatic stress disorder (PTSD) in women with eating disorders (EDs). In addition, the frequency of somatoform complaints was investigated in patients with PTSD compared to those without PTSD. METHOD: 101 ED patients (26.4 years, SD = 7.4) from an outpatient department were investigated by means of standardized questionnaires. RESULTS: 63.3% of the anorexic and 57.7% of the bulimic patients had experienced at least one trauma in their life. 10% of the anorexic and 14.1% of the bulimic patients fulfilled the study definition for a current diagnosis of PTSD. Patients with a comorbid PTSD reported somatoform symptoms more frequently than patients without PTSD (p < 0.001). DISCUSSION: These findings provide additional support for the association between somatization and PTSD in ED patients. In addition, clinical interventions for traumatized ED patients may benefit from a focus on posttraumatic stress symptomatology.

[What can weight losses in anorexia nervosa predict about the premature termination of treatment?]. / Was können Gewichtsverläufe bei Anorexia Nervosa über den Ausgang eines vorzeitigen Therapieabbruches vorhersagen?

It was analysed if the weight course in the first half of a four-step psychosomatic treatment program for inpatients with Anorexia nervosa (AN) was useful to predict premature termination of treatment. The weight courses, sociodemographic and disorder-related data of 121 female adult inpatients were investigated. 39% of the studied patients did not reach their target weight (not completers). 61% of the patients completed all four steps of treatment (completers). The not completers showed significant more time with weight losses in the first step and had more and bigger weight losses in the second step of treatment than the completers. Furthermore, they had fewer comorbid depression. In contrast to the sociodemografic and disorder-related data, the weight courses in the first treatment half were very useful to predict premature termination of treatment for inpatients with AN.

Cycle and gender-specific cerebral activation during a verb generation task using fMRI: comparison of women in different cycle phases, under oral contraception, and men.

Recent observations have revealed some evidence of the influence of sex and menstrual cycle on cognitive functions. In order to examine further differences depending on different phases of menstrual cycle, the use of oral contraception, and gender, fMRI during verb generation tests was performed in 12 female volunteers at menstrual phase and at luteal phase, 12 female volunteers under oral contraception, and in 12 men. Females under oral contraception compared to females in the menstrual or luteal phase revealed superior activation during verb generation in the right hemisphere; compared to menstrual phase in the superior temporal and in the luteal phase in the inferior frontal cortex. Two further significant activations were revealed comparing females in the luteal phase with males; for the females in the left inferior frontal and for the males in the left superior temporal cortex. Our results indicate that cerebral activity during a verb generation task differs between women during different phases of the menstrual cycle and men, between women under oral contraception and men, as well as between women with and without oral contraception.

Depression and protective factors of mental health in people with hepatitis C: a questionnaire survey.

BACKGROUND: Most studies investigating the effects of chronic hepatitis C (HCV) infection on the central nervous system have focused on cognitive impairment or on the health-related quality of life, but only few on depression. OBJECTIVES: This study investigated depression in HCV-infected people. Sense of coherence and social support were surveyed as protective factors of mental health. METHODS: In a cross-sectional study-design, 81 HCV-infected people with mild liver disease, who were not receiving antiviral therapy, were surveyed by validated measures. Anxiety (HADS), depression (BDI), psychopathological symptoms (SCL-90-R), social support (F-SozU) and resilience (SOC) were assessed. RESULTS: Higher levels of depression than normal controls (p=.001) and a wide range of psychological symptoms were associated with HCV infection. Women, single participants, and persons with a shorter interval after first diagnosis exhibited significantly higher scores of depression. Gender and sense of coherence predicted depression scores in HCV people (R(2)=.42, p<.001). CONCLUSIONS: The expression of depression in HCV-infected people is modulated not only by biological but also by psychological factors of mental health. Sense of coherence as a protective factor has a significant impact on the degree of depression. Furthermore, the high prevalence of depression and anxiety among persons not receiving antiviral therapy justifies psychosocial screening and support for HCV people independent of antiviral therapy.

[Screening for distress in women with breast cancer diagnosed for the first time: employment of HADS-D and PO-Bado]. / Screening von psychischen Belastungen bei erst erkrankten Brustkrebspatientinnen: Einsatz von HADS-D und PO-Bado.

OBJECTIVES: In the context of an intensification of efforts to ensure sufficient psychooncological care for breast-cancer patients, the discussion concerning valid psychometric screening instruments gains a special relevance. METHODS: The discriminant and diagnostic validity of HADS-D and PO-Bado were investigated in a sample of 123 women with breast cancer diagnosed for the first time. RESULTS: An ROC analysis revealed a cut-off score of greater than 9 for the subscale anxiety (sensitivity: 50%; specificity: 90%) for the use of HADS-D among breast cancer patients, whereas the recommended cut-off value was greater than 7 (sensitivity: 56%; specificity: 80%) for the subscale depression. Based on the anxiety and depression scores measured by HADS-D, 74% of the clinical cases could be classified correctly. Scores for physical and mental distress measured with PO-Bado were significantly lower in the investigated sample than in the control sample. CONCLUSIONS: HADS-D has only a moderate sensitivity for the group at hand. PO-Bado is a comprehensive basic documentation for specific psychooncological distress, though without cut-off values it is not useful as a screening instrument.